B-2018-1671BUILDING PERMIT
CUPERTINO
CITY HALL
10300 Torre Avenue • Cupertino, CA 95014-3255
PHONE 408-777-3228
WWW.CUPERTINO.ORG
BUILDING ADDRESS: 11406 LINDY PL CUPERTINO, CA
OWNER'S NAME: HIRANO KELLY W AND CAROLYN B
OWNER'S PHONE: Not Provided
CONTRACTOR: J S GENERAL CONSTRUCTION BUILDERS INC, 2995 WOODSIDE RD STE 620313 WOODSIDE
CONTRACTOR PHONE:
DATE ISSUED 8/20/2020 2:14:13 PM
ISSUED BY: KDUNBAR
VALUATION: $500000
JOB DESCRIPTION
SF) WITH OUTDOOR SHOWER/STORAGE AREA (129 SF) AND A (N) COVERED PATIO (179 SF) AND ROOF DECK (565 SF); (N) DECK AT MAIN RESIDENCE WITH
(572 SF); SITE RETAINING WALL (141 LF); DEMO EXISTING POOL (500 SF). (SEE B-2019-0196 FOR (N) POOL PERMIT)
CONSTRUCT (N) ADU (412
BRIDGE TO ADU ROOF DECK
LICENSED CONTRACTOR DECLARATION
of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full
CONTRACTOR:
LICENSED
LICENSED
EXP
I hereby
force
I hereby
J S GENERAL CONSTRUCTION BUILDERS INC
CLASS: C10 ELECTRICAL, C36 PLUMBING
NO: 587615
DATE: 02/29/1992
affirm that I am licensed under the provisions
and effect.
affirm under penatiy of perjury one of the
I have and will maintain a certificate of consent
for which this permit is issued.
I have and will maintain Worker's Compensation
I certify that in the performance of the work
laws of California. If, after making
with such provisions or this permit shall be
following three
to self -insure
Insurance,
for which this permit
this certificate
deemed revoked.
declarations:
for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the
work
as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
is issued, I shall not employ any person in any manner so as to become subject to the Worker's
of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith
V
issued.
Compensation
comply
HAZARDOUS MATERIALS DISCLOSURE
under Chapter
and the Health
6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance
I have read the hazardous materials requirements
the Cupertino Municipal Code, Chapter 9.12
le
with
equipment
Municipal
& Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use
defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino
25505, 25533, and 25534.
or devices which emit hazardous air contaminants as
Code, Chapter 9.12 and the Health & Safety Code, Sections
EPA LEAD -SAFE DISCLOSURE
responsible for this project.
Firm Certification No:
this project.
An EPA Lead -Safe Certified Renovator will be
Firm Name:
No EPA Lead -Safe Certified Firm is required for
Certified
V
CONSTRUCTION LENDING AGENCY
is a construction lending agency for the performance of the work which this permit is issued (Section 3097, Civil Code).
Lender's Address:
I hereby
affirm
under penalty of perjury that there
No
�YesV
Lender's
Name:
APPLICATION CERTIFICATION
that the above
of this city to
costs,
non -point source
information is correct. I agree to comply with all city and county ordinances and state laws relating to building
enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep
and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,
regulations per the Cupertino Municipal Code, Section 9.18.
I certify that I have read this
construction, and hereby
harmless the City of Cupertino
the applicant understands
Signature:
.